Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
Department of Biomedical Engineering, University of Basel, Basel, Switzerland.
J Orthop Traumatol. 2023 Sep 21;24(1):52. doi: 10.1186/s10195-023-00723-5.
While clinical and patient-reported outcomes have been investigated in patients after InternalBrace™-augmented anterior cruciate ligament repair (ACL-IB), less is known regarding restoration of functional performance. We aimed to determine differences in functional performance within and between patients 2 years after ACL-IB, patients 2 years after ACL reconstruction (ACL-R), and healthy controls.
A total of 29 ACL-IB, 27 ACL-R (hamstring autograft), and 29 controls performed single-leg hop (maximum forward distance hop, SLH; side hop > 40 cm in 30 s, SH), proprioception (knee joint position sense at 30° and 60° flexion), and dynamic postural balance (Y Balance) tests. Differences were calculated within groups (side-to-side difference) and between the involved leg of patients and the non-dominant leg of controls, and were evaluated to predefined statistical (P < 0.05), clinically relevant, and methodological (smallest detectable change) thresholds. The number of exceeded thresholds represented no (0), small (1), moderate (2), or strong (3) differences. In addition, the relative number of participants achieving leg symmetry (≥ 90%) and normal performance (≥ 90% of the average performance of the non-dominant leg of controls) were compared between groups (chi-squared tests, P < 0.05).
We observed no-to-moderate leg differences within ACL-IB (moderate difference in hops) and within ACL-R (moderate difference in knee proprioception), no leg differences between patient groups, no-to-small leg differences between ACL-IB and controls, and no leg differences between ACL-R and controls in functional performance. However, two patients in ACL-IB and ACL-R, respectively, passed the hop pretest only with their uninvolved leg, and fewer patients after ACL-IB and ACL-R than controls reached a leg symmetry and normal leg performance of controls in SLH (P < 0.001).
Functional performance seems to be comparable 2 years postoperatively between ACL-IB and ACL-R for a specific subgroup of patients (i.e., proximal ACL tears, moderate activity level). However, the presumed advantage of comparable functional outcome with preserved knee structures after augmented ACL repair compared with ACL-R, and the tendency of both patient groups toward leg asymmetry and compromised single-leg hop performance in the involved legs, warrants further investigation. Level of Evidence Level III, case-control study. Trial registration clinicaltrials.gov, NCT04429165 (12/09/2020). Prospectively registered, https://clinicaltrials.gov/ct2/show/NCT04429165 .
虽然已经对 InternalBrace™增强前交叉韧带修复（ACL-IB）后患者的临床和患者报告的结果进行了研究，但对于功能表现的恢复知之甚少。我们旨在确定 ACL-IB 后 2 年、ACL 重建（ACL-R）后 2 年的患者与健康对照组之间的功能表现差异。
共有 29 例 ACL-IB、27 例 ACL-R（腘绳肌腱自体移植物）和 29 例对照组患者进行单腿跳跃（最大向前距离跳跃，SLH；30 秒内侧向跳跃>40cm，SH）、本体感觉（膝关节位置感在 30°和 60°屈曲时）和动态姿势平衡（Y 平衡）测试。在组内（侧间差异）和患者受累腿与对照组非优势腿之间计算差异，并根据预设的统计学（P<0.05）、临床相关和方法学（最小可检测变化）阈值进行评估。超过阈值的数量表示无（0）、小（1）、中（2）或强（3）差异。此外，还比较了各组之间达到腿部对称性（≥90%）和正常表现（≥非优势侧的 90%对照组的表现）的参与者的相对数量（卡方检验，P<0.05）。
我们在 ACL-IB 内（跳跃时中度差异）和 ACL-R 内（膝关节本体感觉中度差异）观察到无至中度腿部差异，在患者组之间无腿部差异，在 ACL-IB 和对照组之间无至轻度腿部差异，在 ACL-R 和对照组之间无腿部差异在功能表现方面。然而，ACL-IB 和 ACL-R 中各有 2 名患者仅用未受累的腿通过了跳跃预测试，ACL-IB 和 ACL-R 后达到对照组腿部对称性和正常腿部表现的患者少于对照组（P<0.001）。
对于特定亚组患者（即前交叉韧带近端撕裂、中度活动水平），ACL-IB 和 ACL-R 术后 2 年的功能表现似乎相似。然而，与 ACL-R 相比，增强 ACL 修复后保留膝关节结构的可比较功能结果的预期优势，以及两组患者在受累腿中腿部不对称和单腿跳跃表现受损的趋势，都需要进一步研究。证据水平 III 级，病例对照研究。试验注册 clinicaltrials.gov，NCT04429165（2020 年 12 月 9 日）。前瞻性注册，https://clinicaltrials.gov/ct2/show/NCT04429165。
